July 2016 www.womanthismonth.com PARENTING | advice 80 TO VACCINATE OR NOT TO VACCINATE? I’ve read a lot about the human papillomavirus vaccine (HPV) for young girls. My doctor is advising it but there seems to be some controversy surrounding it. What are your thoughts please doctor? HPV has long haunted the human race; nearly all sexually active adults carry some of HPVs’ 170 strains. And while many of these are harmless, amid the multitude mutants there are those with effects that are anything but benign: subtypes 6 and 11 can lead to genital warts; subtypes 16 and 18, amongst others, can lead to cervical, vulvar, vaginal, penile, anal and oral cancers. Type 16 together with type 18 is responsible for 70 per cent of the cases of cervical cancer in Europe; and types 6 and 11 together are responsible for around 90 per cent of cases of genital warts. This is not some mere hypothetical risk – over 90 per cent of cervical cancers are caused by HPV, a cancer which claimed the lives of 270,000 women worldwide in 2012 alone. Cervical cancer is the most common cancer among women aged 15 to 34. Unlike the majority of cancers, it is mainly a disease of the young, with 62 per cent of cases occurring in women who are under 50. The American Cancer Society's estimates for cervical cancer in the United States for 2016 are: l About 12,990 new cases of invasive cervical cancer will be diagnosed. l About 4,120 women will die from cervical cancer. The vaccine currently used in the UK is called Gardasil. It was chosen over an alternative called Cervarix because it gives wider protection. In clinical trials, Gardasil was over 99 per cent effective at averting cancer caused by HPV types 16 or 18 in young women, and it is expected that vaccination will reduce the number of cases of the most common kind of cervical cancer by at least 70 per cent. However, it is important that girls who are vaccinated continue to take up the offer of cervical smear testing later in life, so that other kinds of cervical cancer can be picked up. HPV world-wide vaccine programmes are currently being appraised. Evidence from these shows falling numbers of young people with pre-cancerous cells, and protection from the HPV vaccine is expected to be long-term. The Public Health England 2015 report shows a significant fall in HPV infections in young women since the vaccine was introduced. In 2010-13, HPV types 16 and 18 were 66 per cent less common in sexually active young women aged 16 to 18 than they were in 2008. These early findings support the view that the HPV vaccination programme will have an impact on the numbers of cases of cervical cancer in future. Before September 2014, girls in the UK received three doses of the HPV vaccine. However, from September 2014 the number of doses was reduced from three to two for those who first receive the vaccine aged 12 to 13. This was because research has demonstrated that two doses of the vaccine give a level of protection that is just as good and lasts just as long as three doses, as long as girls are aged 12 to 13 at first dose. For those who start the vaccination course over the age of 13, it is recommended that they continue to receive the three doses. In Australia, data from sexual health clinics illustrate that cases of genital warts in younger women have fallen since vaccination was initiated. In 2007, the year HPV vaccination started, over 11 per cent of women under 21 were diagnosed with genital warts at their first visit to a clinic. By 2014 this number had fallen to just over one per cent. There was also a decline in cases among 21 to 30-year-old women; some of these would have been vaccinated against HPV. In the over 30 age group, who did not receive HPV vaccination, there was no change between 2007 and 2014. Sadly, scaremongering anecdotes without scientific evidence all too often masquerade unchallenged as public interest stories, and the Gardasil controversy is no exception. The question is are they anti-cancer or are they anti-sex? A major apprehension appears to be that without the trepidation of genital warts or cervical cancer, young individuals will become more promiscuous, and that the HPV vaccine hence, in effect, promotes behaviour deemed immoral. We cannot afford to allow squeamishness on the subject Dr Jinan Harith Darwish is a paediatric allergy specialist and clinical immunology fellow at the King Faisal Specialist Hospital & Research Center. Each month she answers your parenting questions. Need to Know
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